158 So. 3d 900
La. Ct. App.2015Background
- Irene Taylor (age 40, obese, history of three C-sections and tubal ligation) saw OB-GYN Dr. Elizabeth Blanton for heavy bleeding from uterine fibroids after conservative therapy (Depo-Provera) failed.
- Dr. Blanton recommended hysterectomy or myomectomy over continued medical therapy; Taylor initially refused but consented to a total laparoscopic robotic hysterectomy in July 2008 and signed the consent form (which listed perforated bowel as a risk).
- During surgery the plaintiff’s bowel was perforated; she suffered significant pain and injury but a medical review panel found no breach of the standard of care.
- Taylor sued for medical malpractice, alleging lack of informed consent because Dr. Blanton did not disclose Lupron (a GnRH agonist) or other ACOG-listed alternatives as reasonable therapeutic options.
- At bench trial, defense experts (Drs. Blanton and Nolan) testified Lupron is a temporary, often preoperative measure primarily to facilitate vaginal hysterectomy and was not reasonable or safe for Taylor (given prior C-sections, obesity, fibroid size); plaintiff’s expert (Dr. Tappan) disagreed.
- The trial court credited the defense experts, found Lupron was not a reasonable alternative for Taylor, ruled Taylor failed to prove lack of informed consent, and dismissed the claim; the appellate court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Dr. Blanton violated the informed-consent duty by not disclosing Lupron and other ACOG alternatives | Taylor: Dr. Blanton had a statutory duty to disclose reasonable therapeutic alternatives, including Lupron; if informed she would have declined surgery | Blanton: No duty to disclose alternatives she considered not feasible or reasonable for this patient; Lupron was temporary, had side effects, could complicate surgery and would not change long-term outcome | Court: Held for defendant — physician need only disclose reasonable/feasible alternatives; plaintiff failed to prove Lupron was a reasonable alternative for her circumstances |
| Standard for reviewing factual findings about informed consent | Taylor: (implicit) trial court erred in crediting defense experts | Defense: Credibility determinations by factfinder are entitled to deference | Court: Applied manifest-error standard and deferred to factfinder’s credibility determinations; not manifestly erroneous to credit defense experts |
| Scope of physician’s duty under Louisiana law | Taylor: Statute required disclosure of alternatives listed in ACOG bulletin | Defense: Louisiana law requires disclosure of reasonable therapeutic alternatives only, not every possible option | Court: Confirmed jurisprudence — duty limited to sufficient information and reasonable/feasible alternatives, not every possible treatment |
| Causation element of informed consent claim | Taylor: Had she known about Lupron she would have chosen differently | Defense: A reasonable patient in Taylor’s position would still have consented to hysterectomy | Court: Held plaintiff failed to prove a reasonable patient would have rejected surgery in favor of Lupron |
Key Cases Cited
- Rosell v. ESCO, 549 So.2d 840 (La. 1989) (manifest-error standard for appellate review of factual findings)
- Snider v. Louisiana Medical Mut. Ins. Co., 130 So.3d 922 (La. 2013) (physician must disclose reasonable therapeutic alternatives; factfinder credibility deference)
- Pertuit v. Tenet Louisiana Health Sys., 49 So.3d 932 (La. App. 4th Cir. 2010) (physician not required to disclose alternatives that are not feasible or appropriate)
- Hondroulis v. Schuhmacher, 553 So.2d 398 (La. 1989) (informed consent doctrine protects patient’s right to decide what is done to their body)